NPIMap

Organization Active NPI

Professional Group Living,LLC

  • Developmentally Disabled Services Day Training Agency
  • Raleigh, NC
National Provider Identifier
1982844635
Registry record updated Feb 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
License
MHL082075 Issued in NC
Legal business name
PROFESSIONAL GROUP LIVING,LLC
Practice address
4084 Barrett Dr
Raleigh, NC 27609-6604
Phone
(919) 785-9660
NPI assigned
Feb 20, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Llewellyn Hicks, MSW
Title
Owner
Phone
(910) 592-2338

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X MHL082075 NC Primary

Addresses

Primary practice location

4084 Barrett Dr
Raleigh, NC 27609-6604

Mailing address

715 Southwest Blvd
B
Clinton, NC 28328-4636
Phone (919) 592-2338

National Provider Directory

National Provider Directory
Tax ID family
Professional Group Living LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

715 Southwest Blvd
#B
Clinton, NC 28328
Phone (910) 592-2338

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1235088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235088000000",
    "number": "1982844635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 SOUTHWEST BLVD",
            "address_2": "B",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283284636",
            "telephone_number": "919-592-2338",
            "fax_number": "910-592-5508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4084 BARRETT DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276096604",
            "telephone_number": "919-785-9660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL GROUP LIVING,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-20",
        "last_updated": "2009-02-20",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "LLEWELLYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-592-2338",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NC",
            "license": "MHL082075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.